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The topic of mental illness seems to come up frequently these days – inevitably, it seems, after another mass shooting. Many see it as an excuse not to talk about guns or other important issues, but it’s certainly true that the U.S. has had a difficult relationship with mental illness. Instead of receiving treatment, many of this country’s mentally ill end up on the streets or behind bars.

Inspiration for Roth’s book came after years of reporting on criminal justice and how race and poverty play into the system. Roth noticed a decrease in conversation around mental illness after seeing jails fill up with mentally ill criminals whose conditioned worsened the longer they were locked up.

In her book, Roth says half of all incarcerated criminals have a psychiatric disorder – and these individuals are treated differently in different states.

“One of the tricky things about this is that the criminal justice system, we talk about it as this entity, when in reality it’s a patchwork of different entities,” Roth says. “So what you’re seeing there in Texas is very different than what I’m seeing here in New York, and each of those jurisdictions may define mental illness differently.”

She says the widely accepted narrative is that the issue is mainly about deinstitutionalization. During the mid-20th century, patients with mental illness were directed into an institution or asylum. Once the system began to deteriorate, many mentally ill people were let out of institutions, with no care. Many wound up in prison instead.

But Roth says there’s more to the story.

“I think this is also part of this larger story of mass incarceration,” she says. “All the things that have drawn millions of people into the criminal justice system in this country have also drawn people with mental illness.”

In Bexar County, though, they’ve found an alternative solution that’s a model to cities across the country.

San Antonio created a restoration center to serve as a one-stop shop for police to drop off mentally ill individuals from the streets. After a simple check-in process, mentally ill patients can stay until they’re stable. After leaving the center, Roth says, patients are less likely to be repeat offenders.

“They’re connected to services in the community,” Roth says. “So they’re not just let out to go repeat the cycle all over again.”

While mental illness is still taboo in the U.S., the narrative about physical illnesses like HIV, AIDS and cancer has changed.

“We have really flipped that around,” Roth says. “People march to raise money for a cure or raise money for treatment, things like that. I think we can get to that point with mental illness, and I think when we get to that point we can fix things.”